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The Psychological Sequelae of Abortion: Myths and Facts
A Symposium held on May 31, Berne, Switzerland

Background to the Symposium

In March 2001, the Swiss National Council, the parliament's largest chamber, voted to legalise abortion up to the 12 week of pregnancy. Previous to this vote, abortion in Switzerland has been regulated by the 1942 penal code. According to articles 118-121 of this code, abortion is a criminal offence unless it is done by a doctor to save the woman's life or in order to avoid risk of severe and lasting damage to the woman's health. Such danger has to be confirmed in writing by a second doctor. Over the last 25 years, practice in abortion provision has, however, become liberal in most parts of Switzerland, as 'health' has been interpreted by doctors according the WHO definition, of not merely absence of disease, but a state of well-being. There have been no successful prosecutions for illegal abortion since 1988.

There have been several unsuccessful attempts to change the law since 1942. A recent campaign, headed by the Working Group on Pregnancy Termination, an alliance of women's groups, has however been successful in its campaign for law reform. According to the new legislation, abortion in the first 12 weeks of pregnancy (from the first day of the last menstrual period) is to be allowed at the request of the woman, who feels she is in a state of distress. The doctor has to obtain informed consent, and provide her with addresses of specialised counselling services. Abortion can be performed in a hospital or authorised doctor's offices. After 12 weeks, abortion is to be allowed if, according to a doctor's advice, it is necessary to avoid a severe danger to the physical health of the woman or severe psychological stress.

The new law has been opposed, and the Christian Democratic People's Party (CDP) has said it will attempt to force a referendum on the issue. Groups opposed to abortion are collecting signatures (100 000 are required) to ask for this referendum. During debate about the new law, the CDP did propose a measure, which was rejected, that would have required women to undergo 'independent counselling' before having an abortion. CDP President Adalbert Durrer argued that without such a clause, the law 'offered totally insufficient protection' to 'unborn life' and that the decision to have an abortion 'should not be considered by the woman alone'. Part of the argument made by groups opposed to abortion, for their case for a referendum, is that women suffer severe psychological damage from abortion (a 'post-abortion syndrome') and that laws and counselling should deter women from abortion. The referendum will probably take place at the end of 2001.

In this context, a Symposium was organised to discuss research about the psychological effects of abortion, and in particular to consider the findings of studies about this issue. The Symposium was supported by the Swiss Society of Psychiatry and Psychotherapy, The Federation of Swiss Psychologists, The Swiss Association of Psychotherapists, The Swiss Foundation for Sexual and Reproductive Health, The Swiss Family Planning Society an the Swiss Society for Public Health.

Summaries of papers covering research findings discussed at the Symposium follow. To access the full text of a paper by Dr Ellie Lee given at the Symposium, entitled 'The context of the development of 'Post-Abortion Syndrome'' click here

A Regional Prospective Study of Psychical Sequelae to Legalized Abortion
Barnett, W., Freudenberg, N., and Wille R.
Fortshr. Neurol. Psychiat. 54 (1986) 106-118 (full paper is published in German)

117 (45%) of the 263 women of German nationality who underwent socially indicated abortions in the postal-code area 2300 (Kiel) in the first quarter of 1982 were investigated before abortion as well as one year later. As far as age, marital status and number of children were concerned, these women did not differ significantly from the other 55%.

One year later information was collected on the women's emotional adjustment by means of a questionnaire concerning feelings of guilt and loss, personal reports of adjustment process, and the investigator's judgement. According to the findings, 79% of the women had adjusted without any problems, 14% were still in a state of emotional imbalance, 7% were clearly impaired emotionally and in their everyday functioning

21% of the women who had adjustment problems, had already been more depressive before the abortion. One year later, they were also more depressive than the other women, more dissatisfied with their lives in general and with their sex lives. They were in greater doubt as to whether they had made the right decision, showed less inclination to consider a further abortion and reported stronger post-abortive feelings of guilt.

Significantly connected with later emotional difficulties were low social class, a difficult financial situation, lack of intrapsychic differentiation between sex and reproduction, no partner or negative relation with partner and partner disagreements, particularly in the case where the male partner was more in favour of abortion than the woman. Statistically insignificant, although tendencially noticable, were social isolation, non-employment and pre-pregnancy psychical problems. Age, marital status, number of children, simultaneous abortion/sterilisation, previous abortions, a broken home in the patient's youth had no effect on emotional adjustment after abortion.

The common factor of all variables predicting post-abortive emotional problems seems to be an external motivation for abortion together with a greater ambivalence towards the pregnancy.

Sexuality, partner relations, and contraceptive practice after termination of pregnancy.
Bianchi-Demicheli, F. et al.
Journal of Psychosomatic Obstetrics and Gynaecology (forthcoming)

The aim of this study was to determine the influence of termination of pregnancy (TOP) on women's sexual well being, the couple and contraceptive practice.

In a prospective qualitative and quantitative study, 103 women undergoing induced abortion by vacuum aspiration were interviewed before the abortion and 6 months later. The interview was performed by means of a questionnaire including open and closed questions, and two psychological tests (Locke-Wallace and Horowitz). After TOP, the majority of women did not report changes in their sexual behaviour and satisfaction. Eighteen percent of women reported a decrease in sexual desire and 17 percent orgasmic disorders. About one third of women described psychosomatic symptoms, but a minority was traumatised by the event. Ninety-eight per cent of the women were informed about, and had practised contraception in the past; 69 per cent had actually used some kind of contraception during the menstrual cycle that had resulted in pregnancy (31 per cent had unprotected intercourse). Six months later, 83 per cent practised contraception, and only 17 per cent did not. Fourteen out of 84 couples separated after TOP (one out of six).

Six months after TOP, the large majority of women interviewed seemed able to cope with TOP. A minority presented some persisting sexual dysfunctions and/or some psychosomatic symptoms.

The Relationship of Abortion to Well-being: Do Race and Religion Make a Difference?
Nancy Felipe Russo and Amy J. Dabul
Professional Psychology, Research and Practice, 1997, Vol. 28, No , 23-31

Relationships of abortion and childbearing to well-being were examined for 1,189 Black and 3,147 White women. Education, income, and having a work role were positively and independently related to well-being for all women. Abortion did not have an independent relationship to well-being, regardless of race or religion, when well-being before becoming pregnant was controlled. These findings suggest professional psychologists should explore the origins of women's mental health problems in experiences predating their experience of abortion, and they can assist psychologists in working to ensure that mandated scripts from 'informed consent' legislation do not misrepresent scientific findings.

Termination of Pregnancy and Psychiatric Morbidity
Anne C. Gilchrist, Philip C. Hannaford, Peter Frank and Clifford R. Kay
British Journal of Psychiatry (1995), 167: 243-48

Background.We investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy.

Method.This was a prospective cohort study of 13 261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321).

Results.Rates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3-0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95% CI 1.1-2.6), or who were refused a termination (RR 2.9, 95% CI 1.3-6.3).

Conclusions. The findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found
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